System and resource barriers
There are extensive system factors contributing to delays
in accessing assessment. The shortage of services often
results in prolonged waiting lists for assessment, meaning
that by the time of assessment, patients may be
demotivated or otherwise less likely to engage in what is
offered. Tatham et al. [15] trialled an active ‘opt in’
waitlist management strategy for an ED clinic, whereby
following initial assessment patients were required to
actively select to remain on the waitlist for treatment.
While ‘opting in’ letters may reduce the waiting time for
an assessment [16], this triage approach is not without
significant risk. Specifically, those most in need of
assessment may be the least able or willing to ‘opt in’.
Long assessment waiting lists are likely to pose a barrier
to engaging in any subsequent assessment - just as these
do in many other health settings. It has been reported by
patients that this can send a distorted message that thedisorder is not serious enough. World-wide, services are
caught in the ethical dilemma of setting priorities for how
scarce resources should be allocated and prioritised. As
these decisions have major clinical implications, resource
priority-setting should be reviewed at regular intervals.
Suggested strategies that have been shown to increase the
likelihood of a valid referral resulting in an assessment include
direct phone contact with the patient [14] accurate
written knowledge services and, where appropriate, steps
to engage significant others (for example, family) in the
assessment process [11].
System and resource barriersThere are extensive system factors contributing to delaysin accessing assessment. The shortage of services oftenresults in prolonged waiting lists for assessment, meaningthat by the time of assessment, patients may bedemotivated or otherwise less likely to engage in what isoffered. Tatham et al. [15] trialled an active ‘opt in’waitlist management strategy for an ED clinic, wherebyfollowing initial assessment patients were required toactively select to remain on the waitlist for treatment.While ‘opting in’ letters may reduce the waiting time foran assessment [16], this triage approach is not withoutsignificant risk. Specifically, those most in need ofassessment may be the least able or willing to ‘opt in’.Long assessment waiting lists are likely to pose a barrierto engaging in any subsequent assessment - just as thesedo in many other health settings. It has been reported bypatients that this can send a distorted message that thedisorder is not serious enough. World-wide, services arecaught in the ethical dilemma of setting priorities for howscarce resources should be allocated and prioritised. Asthese decisions have major clinical implications, resourcepriority-setting should be reviewed at regular intervals.Suggested strategies that have been shown to increase thelikelihood of a valid referral resulting in an assessment includedirect phone contact with the patient [14] accuratewritten knowledge services and, where appropriate, stepsto engage significant others (for example, family) in theassessment process [11].
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